Management of cholestasis of pregnancy typically involves

Ursodeoxycholic acid, cool baths and regular EFM, Low fat diet, ursodeoxycholic acid and regular EFM

What is the primary effect of intravenous Labetalol?

Decreased peripheral vascular resistance

A woman with moderate to severe cardiac lesion is most at risk during

Immediately after birth (before third stage)

When is pre-existing / chronic hypertension usually apparent in pregnancy?

Before conception or before th 20th week

What effect does maternal insulin resistance have on the foetus during pregnancy?

It ensures the foetus receives adequate glucose

What is the main difference between dizygotic (DZ) and monozygotic (MZ) twins?

DZ twins develop from 2 eggs, MZ develops from 1 that splits

What happens in a silent or delayed miscarriage?

The foetus has died but is retained in the uterus

Which of the following complications is not typically associated with GDM?

Increased risk of preterm labour

Which of the following scenarios would make a woman an unsuitable candidate for foetal fibronectin testing?

Recent sexual intercourse within 24 hours

What is the most likely cause of the increased protein in the urine during pregnancy

Increased glomerular permeability due to preeclampsia

What is the typical progression of labour birth following PPROM?

Nearly all women proceed to active labour and birth soon after PPROM

What is a common foetal complication associated with GDM?

Foetal macrosomia and neonatal hypoglycaemia

Which of the following statements is true about monozygotic (MZ) twins?

They can share a single placenta or have separate placentas

What is a sign of threatened miscarriage?

Vaginal bleeeding (spotting) before 20/40 possibly with low back pain or AP

Which diagnostic finding is most indicative of HELLP syndrome?

The presence of haemolysis on the blood film

What diagnostic test is performed to assess the risk of preeclampsia?

Full blood count, creatinine levels, LFTs

What is the recommended post natal follow up for women who had GDM in pregnancy?

Annual HBA1C testing and lifestyle counselling to reduce the risk of T2DM

Why is breastfeeding recommended for women with GDM postpartum?

It improves fasting blood glucose, glucose tolerance and lipid levels

What type of insulin regimen is suggested to achieve tight control of BGLs during pregnancy?

Up to four times daily administration with different insulin types

What are the most commonly occurring foetal abnormalities in pregnancies complicated by diabetes?

Cardiovascular and neural tube defects

In cases of PROM what might an ultrasound exam reveal?

Absence of or very low amounts of amniotic fluid

What may indicate impaired renal clearance in pregnancy?

Blood levels of urea and creatinine at the upper end of the range

When caring for a pregnant woman with cardiac problems what are the Signs & Symptoms of cardiac decompression?

Dyspnoea, irregular pulse, persistent coughing

What maternal and foetal complications are associated with chronic hypertension in pregnancy?

Superimposed preeclampsia, FGR and Preterm birth

What previous pregnancy outcome is considered a risk factor for GDM?

Previous unexplained stillbirth

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Grad Dip Complex Care Study Quiz

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Answers

1
Ectopic pregnancy is the commonest cause of direct maternal death in early pregnancy
True
False
2
Management of cholestasis of pregnancy typically involves
Ursodeoxycholic acid, cool baths and regular EFM
Acetylsalicylic acid, calamine lotion and regular EFM
Low fat diet, ursodeoxycholic acid and regular EFM
Antihistamines, calamine lotion and regular EFM
3
What is the primary effect of intravenous Labetalol?
Decreased peripheral vascular resistance
Pregnant foetal death
Prevent renal impairment
Block calcium channels
4
What type of hypertension is diagnosed before 20 weeks gestation
Preeclampsia
HELLP syndrome
Gestational hypertension
Chronic hypertension
5
A woman with moderate to severe cardiac lesion is most at risk during
First trimester
Immediately after birth (before third stage)
Second stage of labour
24-72 hours post partum
6
When is pre-existing / chronic hypertension usually apparent in pregnancy?
Before conception or before th 20th week
During labour and delivery
After the 20th week
During the third trimester
7
Which of the following is not a complication associated with GDM?
Hypertensive disorders
Increased risk of neural tube defects
Reduce risk of caesarean birth
Repeated miscarriage
All of the above
8
What effect does maternal insulin resistance have on the foetus during pregnancy?
It has no significant effect
It decreases foetal glucose production
It ensures the foetus receives adequate glucose
It leads to maternal hypoglycaemia only
9
What is the main difference between dizygotic (DZ) and monozygotic (MZ) twins?
DZ twins are genetically identical while MZ are not
DZ twins always share a single placenta while MZ do not
MZ twins are more common than DZ twins
DZ twins develop from 2 eggs, MZ develops from 1 that splits
10
In late pregnancy placenta hormones cause progressive insulin resistance with decrease insulin efficiency
False
True
11
What supplements are recommended for women with chronic hypertension after 12 weeks of gestation?
Calcium and low dose aspirin?
Calcium and Vitamin C
Folic Acid and Low Dose Aspirin
Vitamin D and Iron
12
What happens in a silent or delayed miscarriage?
The foetus has died but is retained in the uterus
The cervix is dilated with heavy bleeding
The POC or foetus are expelled completely
There is severe infection in the uterus
13
Which of the following tests is not recommended for fake positives if blood contamination occurs (in suspected PROM)
Ferning test
Nitrazine paper test
Ultrasound exam
Placental alpha microglobulin-1 (PAMG-1) test
14
When is birth usually anticipated for women with chronic hypertension in pregnancy?
At or after 37 weeks gestation
Before 37 weeks gestation
Before 34 weeks gestation
15
The placenta is not the primary cause of pre-eclampsia
False
True
16
Cervical excitation refers to the tenderness of the cervix when moved
False
True
17
Where there is a large placental mass, hypertensive disorders are more likely to occur
False
True
18
Prolonged vomiting can be associated with other life threatening complications
False
True
19
What is the primary method for diagnosing pre-term rupture of membranes
Nitrazine paper test
Speculum vaginal exam
Transvaginal ultrasound
Biochemical test for foetal fibronectin
20
Which type of Diabetes is caused by the autoimmune destruction of insulin producing cells in the pancreas?
Maturity onset diabetes of the young (MODY)
Type 1 DM
Type 2 DM
Gestational DM
21
When does gestational hypertension typically occur in pregnancy?
After 20 weeks
After 36 weeks
Before 20 weeks
Between 20 - 36 weeks
22
Which of the following is a common side effect of magnesium sulphate therapy?
Hypotension
Increased urine output
Hypereflexia
Respiratory depression
23
Which of the following complications is not typically associated with GDM?
Increased risk of preterm labour
Increased risk of caesarean birth
Shoulder dystocia
Foetal macrosomia
24
Which of the following scenarios would make a woman an unsuitable candidate for foetal fibronectin testing?
Recent sexual intercourse within 24 hours
Cervix dilated less than 3cm
Intact amniotic membranes
No significant vaginal bleeding
25
What is the target diastolic blood pressure in pregnant women with chronic hypertension?
Less than 95mmHg
Less than 80mmHg
Less than 90mmHg
Less than 85mmHg
26
What symptom might indicate a severe case of HELLP syndrome related to kidney function?
Painful urination
Reduced urine output
Increased Urine Output
Frequent urination
27
Which of the following is not a complication commonly associated with multiple pregnancies?
Pre-term labour and birth
Pre-eclampsia
Placenta praevia
High birth weight
28
What is the most likely cause of the increased protein in the urine during pregnancy
Reduced blood flow to the placenta
Impaired kidney filtration due to hypertension
Inflammation of the urinary tract
Increased glomerular permeability due to preeclampsia
29
What is the typical progression of labour birth following PPROM?
Nearly all women proceed to active labour and birth soon after PPROM
Labour can be delayed indefinitely with appropriate management
Most women remain pregnant for more than 4 weeks post PPROM
Labour does not occur unless induced medically
30
What is a common foetal complication associated with GDM?
Foetal growth restriction and premature labour
Foetal macrosomia and neonatal hypoglycaemia
Neural tube defects and low birth weight
Polyhydramnios and maternal anaemia
31
Which of the following statements is true about monozygotic (MZ) twins?
They can share a single placenta or have separate placentas
They develop from two separate eggs fertilised by two different sperm
They are always different sexes
They are less genetically similar than DZ twins
32
What is a sign of threatened miscarriage?
Complete expulsion of POC or foetus
Vaginal bleeeding (spotting) before 20/40 possibly with low back pain or AP
Heavy vaginal bleeding and uterine contractions
Cervical dilation and rupture of membranes?
33
Which diagnostic finding is most indicative of HELLP syndrome?
The presence of haemolysis on the blood film
Platelets greater than 150000/mm
Anaemia
None of the above
34
What diagnostic test is performed to assess the risk of preeclampsia?
Urine culture
Full blood count, creatinine levels, LFTs
Growth scan
Amniocentesis
35
Women with DM are not at risk from infection?
True
False
36
What is the recommended post natal follow up for women who had GDM in pregnancy?
Insulin therapy for the first 12 months post partum
Monthly BGL monitoring for 6 months post partum
Annual HBA1C testing and lifestyle counselling to reduce the risk of T2DM
No follow up required
37
What is the cure for HELLP syndrome?
Antihypertensive medication
Blood transfusion
Birth of the baby
Magnesium sulfate
38
The commonest site of extrauterine implantation is the uterine tube, usually in the region of the isthmus
True
False
39
Why is breastfeeding recommended for women with GDM postpartum?
It increases insulin resistance
It prevents future occurances of T2DM
It improves fasting blood glucose, glucose tolerance and lipid levels
It eliminates the need for postnatal BGL monitoring
40
What type of insulin regimen is suggested to achieve tight control of BGLs during pregnancy?
Three times daily administration
Single daily administration
Twice daily administration
Up to four times daily administration with different insulin types
41
What gestation does a late stage miscarriage occur?
First trimester
After 20 weeks
Before 20 weeks
Between 13 to 20 weeks
42
Which of the following tocolytic agents is generally preferred due to fewer side effects and effectiveness?
Calcium-channel blockers
Atosiban
Magnesium sulfate
Beta-mimetics
43
What are the most commonly occurring foetal abnormalities in pregnancies complicated by diabetes?
Respiratory and digestive disorders
Cardiovascular and neural tube defects
Skeletal defects and muscular dystrophy
Hearing and vision impairments
44
Which of the following factors is not mentioned as possible aetiology for the rise in late pre-term births?
Decreased maternal nutrition
Increased maternal age
Increased multiple births
Increased use of artificial reproductive technologies
45
In cases of PROM what might an ultrasound exam reveal?
Absence of or very low amounts of amniotic fluid
Increased cervical length
Presence of foetal anomalies
Cord prolapse
46
What is the usual target range for maternal plasma BGLs during labour?
2-4 mmol
6-8 mmol
7-10 mmol
4-7 mmol
47
What may indicate impaired renal clearance in pregnancy?
Blood levels of urea and creatinine at the upper end of the range
High BGL
Low serum albumin levels
Decreased white blood cell count
48
When caring for a pregnant woman with cardiac problems what are the Signs & Symptoms of cardiac decompression?
Dyspnoea, irregular pulse, persistent coughing
Slower heart rate, normal BP and coughing
Shortness of breath, tachycardia, hypotension
Fatigue, increased respiratory rate, frequent urination
49
What maternal and foetal complications are associated with chronic hypertension in pregnancy?
Gestational diabetes, Macrosomia and Placenta Praevia
Preterm labour, oligohydraminos, intrauterine infection
Superimposed preeclampsia, FGR and Preterm birth
Hyperemesis, polyhydraminos, GDM
50
Which of the following is a potential maternal complication of gestational hypertension?
Polyhydramnios
Hyperglycaemia
Pre-term birth
Placenta praevia
51
What previous pregnancy outcome is considered a risk factor for GDM?
Placenta abruption
Previous unexplained stillbirth
Preterm birth
Low birth weight baby
52
For how long is magnesium sulphate therapy typically continued post partum to prevent eclampsia?
12 hours
6 hours
24-48 hours
72 hours
53
What conditions can have symptoms similar to HELLP syndrome?
gastroenteritis and influenza
Asthma and COPD
Hypertension and diabetes
Hepatitis, SLE, antiphospholipid syndrome, Sepsis...
54
What is typically reassessed immediately prior to transport to determine if a transfer is advisable?
Foetal weight
Cervical dilation
Blood test
Maternal observation
55
Which of the following complications is commonly associated with T1DM in pregnancy?
Chronic hypertension
Hypothyroidism
Foetal growth restriction
Polyhydramnios
56
What is the primary characteristic of diabetes mellitus?
Enhanced glucagon production
Low BGL
Excessive insulin production
Impaired carb metabolism & elevated BGL
57
Increased haemaglobin levels and haematocrit suggest the onset of pre-eclampsia
False
True
58
Pre-term labour is defined as beginning:
Before 20 weeks
Before 37 weeks
Before 36 weeks
Between 20-37 weeks gestation
59
What are some complications associated with chronic hypertension in pregnancy?
Exercerbation of hypertension, superimposed PE uteroplacental insufficiency
Hyperemesis gravidarum, polyhydraminos, gestational diabetes
Preterm labour, oligohydraminos, intrauterine infection
Gestational diabetes, macrosomia, placenta praevia
60
What is the significance of a foetal fibronectin (fFn) level greater than or equal to 5mg/ml at or after 22/40?
Indicates low risk of spontaneous pre-term birth
Increased risk of spontaneous pre-term birth
Indicates normal pregnancy progression
Suggests need for immediate delivery
61
In the context of pre-eclampsia, what is significant about a rise in systolic BP?
An increase of 20mmHg above earliest recorded pregnancy reading
An increase of 30mmHg above earliest recorded pregnancy reading
An increase of 10mmHg above earliest recorded pregnancy reading
Any increase is significant
62
What is the most likely cause of epigastric pain in a pregnant woman with a BP of 160/100?
Fibrin deposition in the liver
Placental abruption
Peptic ulcer
Oesophageal reflux
63
What typically happens to maternal insulin secretion during the second and third trimesters?
Stops completely
Increases, leading to hyperinsulinaemia
Remains unchanged
Decreases significantly
64
When is hypertension in pregnancy diagnosed based on BP reading?
Systolic BP >160, diastolic >100
Systolic BP >130, diastolic >85
Systolic BP >120 diastolic >80
Systolic BP >140, diastolic >90
65
What is the primary reason for administering magnesium sulphate to women with severe preeclampsia?
To prevent eclamptic seizures
To reduce proteinuria
To promote foetal lung maturity
To lower BP
66
In a severe case of oedema in the liver cells swelling causes lower abdo pain and can lead to intracapsular haemorrhages
True
False
67
What is the primary function of tocolytic therapy in the management of pre-term labour?
To delay labour 24-48 hours
To treat maternal infections
To stop labour permanently
To induce labour later
68
Medications that may be used pre-conception and during the first trimester for a woman with obstetric lupus include
Folic acid and oral prednisolone
Heparin and vitamin D
Aspirin and calcium supplements
Warfarin and vitamin B12
69
The Cossacks virus B4 causing childhood infection maybe implicated with the onset of T1DM?
True
False
70
For women with gestational diabetes and good glycaemic control, expectant management can continue until at least
37/40
39/40
40/40
36/40
71
Symptoms of pain, bleeding and amenorrhea may be absent in the sub acute phase of ectopic pregnancy
False
True
72
What does chorionicity refer to in a multiple pregnancy?
The genetic similarity between foetuses
The number of amnions surrounding the foetuses
The type of placentation caused by the number of chorionic membranes
The number of placentas shared by foetuses
73
What is not a risk factor for developing preeclampsia?
BMI 35
Diastolic BP <70
Age under 20 years
Previous preeclampsia
74
Which of the following is a risk factor for developing GDM?
Previous baby with low birth weight
Obesity and family history of diabetes
Maternal age over 25yo
Male gender of foetus
75
During pregnancy, what condition is characterised by insulin resistance and compensatory hyperinsulineamia?
Hyperthyroidism
Hypoglycaemia
Type 1 DM
Diabetogenic state
76
Women with GDM are not at risk of developing GDM or developing T2DM later in life
False
True
77
What is the best management strategy for a woman diagnosed with chronic hypertension
Initiate low dose aspirin and calcium supplementation after 12 weeks
Continue ACE inhibitors throughout pregnancy
Administer diuretics throughout the pregnancy
Discontinue all antihypertensives
78
Late pre-term births occur between which gestational weeks?
32-34 weeks
36-38 weeks
34-36 weeks
28-32 weeks
79
Which of the following is NOT a sign of pre-eclampsia?
A rise in BP >140/90
Excessive weight gain without oedema
Development of epigastric pain or RUQ pain
Visual field disturbances
80
Which of the following is a known risk factor for developing GDM in pregnancy?
Polycystic Ovarian Syndrome (PCOS)
Accelerated weight gain
All of the above
Maternal age over 25
81
What is the primary concern for pregnant women with T1DM?
Increased risk of PPH
Increased risk of gestational diabetes
Increased risk of hypertensive disorders
Increased risk of congenital anomalies
82
Which antihypertensive medication is not recommended during pregnancy due to the risk of congenital abnormalities
Methyldopa
ACE inhibitors
Nifedipine
Hydrazine
83
What are the potential pregnancy complications for women with pre-existing diabetes?
Reduced risk of congenital malformations
Decreased risk of miscarriage
Increased likelihood of perinatal morbidity
Increased risk of pre-term labour and pre-eclampsia
84
Which microvascular complication is associated with poor glycaemic control in the first trimester?
Neuropathy
Retinopathy
Liver disease
Cardiovascular disease
85
What condition is listed as a risk factor for GDM?
Polycystic ovarian syndrome
Hypothyroidism
Endometriosis
Ovarian cysts
86
Which of the following factors increases the likelihood of dizygotic (DZ) twinning?
Younger maternal age
Lower maternal parity
Advancing maternal age
Genetic inheritance from the fathers side
87
Which of the following is a potential complication for the mother with GDM during preganncy?
Recurrent miscarriage and hypertensive disorders
Increased risk of congenital heart defects
Hyperthyroidism
Increased risk of developing gestational hypertension
88
Which intervention has been demonstrated to prevent pre-term birth and shortening cervical length?
Cervical cerclage
Continuity of midwifery care
Progesterone administration
Smoking cessation
89
Why might a negative result from a foetal fibronectin or actim partus test be particularly useful?
It indicates a need for immediate tocolytic therapy
It provides confidence that birth is unlikely within 14 days
It confirms the onset of labour
It requires immediate corticosteroid administration
90
In which periods can eclampsia occur?
Intrapartum and postnatal
Antenatal, intrapartum and postnatal
Antenatal, intrapartum
Only antenatal
91
During labour and birth how often should BGLs be monitored in women with diabetes?
In random intervals
Hourly
Every 30 minutes
Every two hours
92
What characterises an inevitable miscarriage?
Vaginal bleeding persists with dilation of internal os or SROM
The foetus is retained in the uterus
The cervix remains closed and the uterus is non-tender
Products of conception or foetus have been expelled
93
What should be considered when chorioamnionitis is diagnosed during preterm labour?
Continuing birth under intravenous antibiotic cover
Discontinuation of foetal monitoring
Immediate inhibition of labour
Continuation of labour without any intervention
94
What laboratory finding is indicative of HELLP syndrome?
High BGL
Elevated WCC
Low platelet count (<100 x 109/L)
Low bilirubin level
95
Why is magnesium sulphate commonly used in obstetric practice during pre-term labour
To stop labour permanently
To prevent maternal infections
To reduce eclamptic seizures and provide neuroprotection to the foetus
To enhance efficacy of corticosteroids
96
Which of the following conditions is least likely to be associated with spontaneous preterm labour?
Hydrops foetalis
Foetal anencephaly
Congenital rubella
Multiple pregnancy
97
What results are considered significant for proteinuria in PCR and ACR tests?
PCR over 30mg/mmol, ACR over 8mg/mmol
PCR over 60mg/mmol, ACR over 12mg/mmol
PCR over 20mg/mmol, ACR over 5mg/mmol
PCR over 50mg/mmol, ACR over 10mg/mmol
98
Why are women with T1DM at higher risk of having an LGA baby?
Due to increased amniotic fluid
Due to the use of insulin in pregnancy
Due to hyperglycaemia leading to foetal hyperinsulinaemia
Due to excessive maternal weight gain
99
Which of the following are common outcomes for babies born to women with pre-existing diabetes?
Macrosomia and neonatal adaptation problems
Lower chances of stillbirth
Reduced risk of birth injury
Decreased risk of congenital malformations
100
What do the letters in HELLP represent in HELLP syndrome?
Hypertension, oedema, liver dysfunction, low platelets
Haemolysis, elevated liver enzymes, low platelets

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